Friday, October 22, 2010

Calling Etotheipi... (The Death Pronouncement Revisited)

My worst medical school moment was when I answered the hot-shit surgeon (who was lecturing us on how to determine clinical death) that one way to determine death might be to hold a mirror under the patients nose and mouth area to see if it fogged-up. Luckily, everyone thought I was kidding, everyone laughed, and I got big props for breaking up an otherwise terribly serious lecture. Lesson learned... only answer serious questions with jokes.

As it turns out there's not a terrific summary on how doctors pronounce death on the web, at least not as I searched it, but here's a start. I wonder, though, if this story makes it advisable to add 'partial mummification' (and the vanishing probe sign) to the list of sure signs of death, you know... just for the sake of completeness.


  1. We had a horse who had cardiac problems who keeled over one day. Dad told me to poke him in the eyeball. I did, and he didn't blink, but I have wondered ever since ... is that what you guys do? Poke people in the eye?

  2. good question peggyU,
    others can chime in, but in general there's a difference between pronouncing death on someone who is obviously dead (partially mummified corpse) and pronouncing death in a patient that you have struggled mightily to save (heart attack, sepsis, etc...). in the latter case, after you have done everything you know how to do and it has all failed i generally ask everyone in the room if we have done everything possible and if it is time to stop... any suggestions are generally followed... when those fail, and this is a relatively new thing, i get the ultraound out and take a look at the heart. no squeeze? strike one, pupils non reactive? strike two. no electrical activity on the heart monitor? strike three. you can also 'poke them in the eye' in a way... you can check for a corneal reflex by gently touching the cornea with a piece of tissue or gauze... they should not blink. then there's the absence of a gag reflex and a whole host of other old school signs. but for me, after coding someone for a while and seeing the heart motionless the game is up and then i have to go tell the family.

  3. I have a special way of testing for absence of a gag reflex.

  4. For real-zies, dead means stiff and cold with a toe tag. If they get to me and they are still alive, then, well, once the internal organs are in a bucket and the brain is on my meat over.

  5. dear etotheipi,
    why is it again that i like you and think you are a good person? oh yeah, the touching-a-spark-to-the-powder-keg impulse control problem.